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Nov. 26, 2012 -- The number of kids sent to emergency rooms after being hurt on blow-up bouncy castles or houses jumped sharply from 1995 to 2010.

And the annual rate doubled between 2008 and 2010, according to research in Pediatrics.

A child in the U.S. is sent to the ER after being injured in a blow-up bouncy castle or house every 46 minutes.

"If this was an infectious disease that was increasing at this rate, there would be headlines across the country. But because it is an injury, it is often overlooked," says study researcher Gary Smith, MD, DrPH. He is the director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

But there are things that parents can do to help make these bouncers safe, including setting age and other limits.

"We can use bouncers more safely, ask national groups to come up with guidelines, and turn to manufacturers and say, 'What can you do to help us?'" Smith says. "If we all work together, it will be more fruitful than prohibition."

Types of Injuries

"Inflatable bouncer" is an umbrella term for many products, including bounce houses and moon walks.

"They are brought home and set up in the backyard for birthday parties or available at bounce centers," Smith says.

Researchers don't know why there is such a steep increase in bouncer injuries but suspect it is due to the increasing popularity of these bouncers. "There is no evidence that the bouncers are getting more dangerous," he says.

Researchers looked at injury rates and patterns among children 17 or younger who were treated in emergency rooms for bouncer-related injuries from 1990 to 2010. The injury rates are likely higher than seen in the study, which just looks at those serious enough to require emergency room visits. "These are the tip of the iceberg," Smith says.

Injuries included sprains, strains, and fractures, mostly in the legs or arms. Boys were more likely to sustain concussions, closed head injuries, or cuts than girls.

So how do these injuries happen? Mostly kids fell. Some fell in or on the bouncer, while others fell out. Some got hurt getting on or off the bouncer.

Just shy of 10% were hurt when colliding or being pushed by another child, and 6.3% were injured when one child fell on another.

In all, 3.4% of children were hospitalized or kept for more than 24 hours after their injury. Broken bones accounted for 81.7% of injuries that required observation or a hospital stay, the study shows.

Tips to Make Bouncy Houses Safer

"Every physical activity has a risk of injury, and this is a real risk," Smith says. Still, too many kids get too little physical activity, and bouncing can be good exercise.

Make it safer by:

Limiting use to kids 6 and older

Making sure there is adequate adult supervision

Banning flips or horseplay

Limiting the number of children on the bouncer

"The worst injuries occur when more than one child is on the bouncer at one time," says Shireen Atabaki, MD, MPH, an emergency room doctor at Children's National Medical Center in Washington, D.C.

"Having multiple children on the bouncer is less safe," she says. "If more than one kid is on the bouncer at the same time, they should be same height, weight, and age."

Prevention is key, says Jose Rosa-Olivares, MD. He is the medical director of the Pediatric Care Center at Miami Children's Hospital in Florida. He routinely counsels families on some of the risks associated with bouncy castles and jumpers.

"If there is the opportunity to redirect the child to a different activity, do that first," he says. "If parents decide it's safe to use these, try to avoid bouncers with a lot of kids jumping at the same time."